The West Point Syndrome

“So what happened? “ said the doctor, leaning over me, “Tell me once or twice from the top. Were you unconscious? ”

It was two thirty in the morning, and Doctor Vivian Westphal had been called in to provide a second opinion on the cause of Peter Doyle’s collapse. How can you sparkle this much this late at night, I wondered. She was slim and in her forties, dressed in black silk blouse and swishy black pants with fancy sandals. Diamonds were dancing on her tassels. A real authentic medical bloodhound snapping out her questions like Inspector McGonigle.

She was a hospitalist, whatever that was; she was in the employ of my health program. She had come to me out of the dark night, probably from some social event. She had sprung me from an ordinary room downstairs and had the nurses wheel me over to critical care to have some telemetry work. She thought I might benefit from a neurological evaluation.

Soon I was in the fourth floor of the critical care ward of our hospital, all hooked up with cardiac monitors. I could see things for myself, I had been studying the lowest line on the monitor, and I knew I wouldn’t last until the morning. The sine waves had a hypnotic splendor, but there was nothing in them that spoke of regularity or reassurance. They spoke of earthquakes, seaquakes, political upheavals, sudden Nebraska-style prairies, and then little blanknesses when nothing at all was happening. My heart was a winded old one-lunger farm engine ready to give a final wheeze and go clunk. Neurology. I didn’t like the sound of that.

“Let’s concentrate,” she said, “Tell me what happened.” She reached up and turned the monitor off.

“Hold on, let me get some help. I’ll be right back.”

Soon a nurse came in, and with the doctor helping, they moved my bed so it faced the window. Outside heavy snow was falling on the half-empty parking lot. Maybe there would be no school tomorrow.

She moved her chair over by my bed, and sat there. She seemed to be watching something behind me.

“ It was like this,” I said.

“Hold it for another minute, Pete.”

I lay there watching the snow fall. The light down at the corner of Elm and Locust went from red to green, but had no audience. The streets were empty. It must be two or three in the morning. The whole world was quiet. In a minute or two the light changed again.

“OK” she finally said, “Tell me what happened.”

I told her there was nothing splendid or even interesting in my last day in normal existence. I had moved some wood out in the back yard, had a glass of wine, a slice of quiche and salad for supper. We had stayed home; we were watching an old episode of LOST on the DVD, episode three. It was about nine fifteen pm. The doctor in the show was working feverishly on the security guard, who had barely survived the plane crash, when the earthquake began at 23 Oak Street. My wife was on the couch; I was sitting in my daddy’s armchair. The whole room began to stagger around me. I sat there patiently and waited for this little episode of dizziness to go away.

“You didn’t stand up and then get dizzy.”

No. But now the dizziness began to gather some force and traction and became the eye of a storm. It lifted me up to my feet with a biblical promise that the end was near. I was going up to heaven. I was walking on tippy-toes, light as a feather, and the floor fell away. Everything began to pitch dramatically, the floor suddenly came back up and smacked me a good one on my chin. The next thing I knew I was down on my knees in the stove room holding onto this spidery antique table and dragging it around as if it could help me somehow. My wife was on her feet and calling to me.

“ Pete, what’s happening, Pete what is going on?

I had no idea of what was going on. The perfect idiot. Who or what was I fighting and why couldn’t I get a decent punch in? I tried to talk and had nothing to say. I somehow made into the bathroom and got my pants down and suddenly there was an awful mess. Twin accidents, pants that had to be gingerly stepped out of.

“What can I do?” Her frightened voice came from far away. “Tell me what to do.”

I was the lord of incontinence, works of great import lay at my feet. I concentrated comically, the good Lord trying to concentrate on what to do. Trying to talk and I couldn’t get anything out. The fecal matter had import. Something was drastically wrong. I thought I needed help. “Call 911.” I said. After a couple minutes the phone was in my hand and I managed not to drop it. Soon I was talking to someone who was calm, oh Lord in heaven how I needed people who were calm and friendly and were doing nothing at the moment but sitting quietly by the phone having a cup of coffee and maybe doing a crossword puzzle. I burbled something in code and he got it. Help was on the way. The first to arrive was a policeman. He saw the mess on the floor, saw me with my skirts up, and took out his notebook.

“They are on their way, Pete.” he said.

I thought I knew him from somewhere. Then was a whole crew of people. A cuff was on my arm, the chief helper whistled when he had a twenty point drop from the next-to nothing reading he had when I was sitting down. That was an impressive stunt, the first of many I was to perform.

“Were you unconscious at any time?” said the doctor. “Would your wife know?”

“She’s asleep now. Don’t bother her.” I knit my brows extensively, and thought about it for a long while.

“I am not such a good observer. “

I looked over at her and shook my head sheepishly and shrugged. I was oddly proud of that little confession. No stories tonight. No dramatic fiction for the doctor, who was trying to help. No exaggerations. I had to think clearly. The lady doctor didn’t like the ER diagnosis. Here she was, a free unsolicited second opinion arriving wearing silk and looking glamorous. There was class-based envy from a plump RN who wondered why Doctor Westphal could keep her figure with so little effort. She wondered why the ER doctor hadn’t noted that this explosion of fecal matter was more consistent with a stroke. I couldn’t grip the doctor’s finger with my right hand as hard as she thought I should. I followed her finger from right rear to left rear. Her clear eyes saw a lot.

“You might have had a seizure or a stroke. There are certain things that are not consistent with a fainting spell caused by an overdose of blood pressure meds.”

“What?”

“Oh, things that were in the ambulance report. Your readings. Your difficulty in talking, fecal and urinary incontinence coming on suddenly that way. Were you on the way to the bathroom in the first place?”

“No.”

“But you ended up there. Why?”

“I don’t know.”

“It reminds me of the West Point syndrome.”

“What?”

“Prolonged periods of extremely low blood pressure can bring on seizures and in some cases, strokes.”

A stroke, I thought, as she concentrated her penlight into my left eye, and then the right.

“Why West Point?”

“Oh” she laughed, “You know West Point. Cadets stand at attention in the boiling sun for hours for inspection. The blood pools in their legs, they often faint. But in West Point, the men on either side of a faintee hold him up to save his honor. Falling is a good thing, they wake right up and no damage is done. Standing when you are unconscious means that the low blood pressure is prolonged, and you get seizures or strokes.”

“Oh”

My father had his stroke in the junior high school gym, three days before his retirement day. His ruddy good-natured Irish alkie glow gradually faded away in the weeks before he died. We just watched him come and go, grey and pasty and resigned. On Thursday March 23rd he was going to come home for good, and then he would have nothing to stay sober for. The buffer went wild as he fell, banging against the walls and crashing about until it finally yanked its cord out and went dead. Later they would mop up the blood and when I got there, the next day, there was nothing to see. The gym floor shone malignantly, the bleachers and the score board were all rigged up for the big game that night with North Quincy. Life went on.

“I noticed something, “ said the doctor. “When I got here you were watching the monitor. I sometimes think we would be better off having them turned off when they are not needed. We turned your bed toward the window. There was a really, and I mean really dramatic drop in your blood pressure in a couple minutes. Here we are pumping the saline into you to get your pressures back up, and now its back down to eighty over 50. If we let you get up, you’d keel over again. “

“Really?” I said. “What does that mean?”

“I don’t know.” she said, “What were you thinking about when you were watching those monitors?”

Out on the distant streets the lights had gone red again. Everyone stop.

“I was worried. I was looking at that monitor and I was scared to death. My lines were all over the map. My old man died of a stroke.”

“Ah,” she said. “ So that is it. I’ll be right back. Think peaceful thoughts. You’ll be here a couple days, I think, until some tests come in. Think about snow. No school tomorrow, I guess. Even the high school is going to be out. 12 to 18 inches Tom Bavaqua said.”

In a few minutes she came back with the nurse and they moved my bed around again so it faced the line of monitors.

“What do you see?” She said. “You are number three.”

No jagged peaks, no cliff-side drops, just a simple sine wave. A slow surge, then a smooth drop then building toward another hilltop. A peaceful series of ocean swells.

“You see it, don’t you?” she said. “I went back and looked at the tape to make sure. The good news is your heart is ok. No signs of coronary disease. But you have all these adrenalin-type surges. You’re emotional, you seem to have a lot of anxiety about things, and I think it is affecting your heart. I looked at your history and you would come into the clinic with these stroke-level readings, and your regular doctor kept cranking up your dosage. Anxiety-related pressures I think. You were taking all the medicine in the morning, and by late in the day they all were working hard, and you weren’t. Let’s wheel him around again, Jennie. And let him get some sleep. ”